The ethics of enhancement.

The quest to build better people.
March 12 2003 3:21 PM

The Ethics of Enhancement

We can make ourselves stronger, faster, smarter. Should we?

Dürer's proportion of man
Dürer's proportion of man
David Plotz David Plotz

David Plotz is Slate's editor at large. He's the author of The Genius Factory and Good Book.

Articles about the possibility of "improving" mankind usually start with ethical chin-stroking and don't get past it. Readers never actually get to hear about the particular fun and bizarre and scary possibilities. During this series, I've intentionally taken the opposite approach. I began the "Superman" project agnostic about enhancement and avoided thinking about ethics until I had finished reporting. Before I started fretting about the morality of it all, I wanted to know what exactly I was fretting about.

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The reporting's over. So, is enhancement a good idea? Is it right (and—a separate question—is it wise?) to give yourself infrared vision or a turbo-memory or MGF-pumped muscles? There is a range of ways to approach these questions.

Would-be enhancers—a category that includes scientists, gung-ho sci-fi fans, muscleheads, longevity nuts, etc.—use two strategies to dismiss ethical questions as irrelevant. First, they claim the coming enhancements are nothing new: We have always enhanced ourselves. As Carl Elliott—not an enhancement advocate, I should say in his defense—points out in his new book Better Than Well, yesterday's enhancement is today's necessity. When Elliott was a boy, such mundane activities as removing warts, medicating acne, and immunizing kids counted as enhancements: They allowed people to improve what had been the inevitable human condition. Glasses, contact lenses, and laser surgery all improve on nature's work, but you don't hear anyone agonizing over them. The supporters of enhancement suggest that tomorrow's improvements are no different. In a generation, we will feel the same way about MGF-buffed pectorals as about nose jobs.

Man, brought to you by technology
Man, brought to you by technology

This argument doesn't persuade me. Today's enhancers have extraordinarily grand ambitions, much greater than zapping warts or enlarging breasts. They crave powers that have been reserved for gods (superhuman strength) or beasts (infrared night vision). They also seek to change human beings permanently—something no previous enhancer could do. Doctors will soon be able swap genes in and out of embryos, protecting children from diseases or perhaps increasing intelligence or adding height. Such "germline engineering" will irrevocably alter the DNA of those kids and of the species. Clearasil, it ain't.

The second argument for enhancement is its inevitability: Consumer demand drives enhancement, so it will happen if people want it, whatever the ethics might be. Just consider the history of cosmetic surgery: Who would honestly claim medical justification for breast implants and nose jobs? But consumers wanted ski-jump noses, and they got ski-jump noses. The same market ruthlessness applies to tomorrow's enhancements.

Such shrugging is also unsatisfactory. Government legislation, moral suasion, journalistic haranguing, and medical self-policing still have huge influence on what kind of enhancements do and don't succeed. The market may make it inevitable that athletes will use EPO, or that students will take Provigil, but that does not answer the question of whether they are right to do so.

Those who oppose enhancement have four major objections:

Should we mess with evolution?
Should we mess with evolution?

Safety Every few weeks a story breaks about another gene therapy trial gone awry. A teenager dies in Pennsylvania. Two toddlers develop leukemia in France. These mishaps are tolerated because the subjects in question would have died without gene therapy in any case. In theory, medicine will tolerate terrible risks to save lives or repair disabilities but not to make patients feel better about themselves. This is the essence of the "therapy/enhancement" distinction favored by medical ethicists.

But the distinction between therapy and enhancement isn't as clear as ethicists contend. Doctors practice enhancement all the time—even frivolous enhancement. Surgeons undoubtedly claim that there's a therapeutic justification for breast enlargements, but they're not kidding anyone.

What's more, a recent revolution in patient expectations has further blurred the cultural value we place on this distinction. In the past generation, doctors have become less authoritarian, and patients better-informed about their condition and the risks and benefits they face. (The Internet and books such as Sherwin Nuland's seminal How We Die have particularly galvanized patients.) The sanctity of doctor-knows-best has been diluted as doctors increasingly accept that a patient can make his own choices, including the choice to take physical risks for the sake of self-improvement.